背 景：瞭解實習目標的落實歷程與關鍵影響因素，可以引導臨床護理實習的進行，有助於護生學習成效的提升，值得探討。
目 的：本文欲探討科技大學臨床護理實習中，實習指導教師落實實習目標的歷程，並分析其影響因素。
方 法：本研究採用參與式行動研究法，也就是透過實習指導教師和研究群的觀點，對每天實習後的護生學習反應及實習目標落實困境等進行檢視，並分析歷程中的關鍵影響因素。本文共蒐集反省記錄、會談紀錄，以及文件等資料，來探討實習指導教師及49位五專護生的實習歷程及實習指導經驗。
結 果：本研究發現，實習目標的落實必須適性，也就是須針對護生的程度和需求。由此，本文設立的實習目標包括：臨床實務能力與省思能力的提升、溝通與合作能力的增進、自主與責任感的培育、以及倫理與關懷素養的提升等。影響實習目標的關鍵因素，主要在教師的角色轉變上，包括實習指導教師依據護生不同階段特性來採用不同的領導方式，以及發展兼顧師生與朋友關係的人際互動。
結論/實務應用：研究建議包括：(一)落實目標時應考量學生的適性發展，並應重視省思能力與倫理概念等目標的養成。(二)護生應深入理解理論的意義、應透過溝通與合作來增進互動能力、應加強自主、責任感及人文素養，以利教育目標的落實。(三)教師的領導應提供護生自主的機會，並在師生關係之外建立朋友關係。

Background: It is critical to understand the process of how learning outcomes are implemented in practice in order to guide clinical nursing practice.
Purpose: The aim of this study was to explore how learning outcomes are implemented and to elicit and analyze the factors that affect this process.
Methods: This study adopted a participatory action research approach. The challenges to implementing student learning outcomes were explored and the factors that affect this process and the solutions were elicited from clinical teachers, from research groups, and from the reflection notes, the interview notes, and other documents of 49 five-year nursing students.
Results: The learning outcomes of nursing clinical practice must be developed to address the needs of students. These needs include the competencies of reflective thinking and practice skills, the ability to communicate and to cooperate, the character of autonomy and responsibility, and the professional identity of ethical attitudes. The factors that influence the implementation of learning outcomes relate primarily to the role of the teacher. The teacher uses a diverse range of leadership styles to develop a friendly relationship with students.
Conclusions / Implications for Practice: The results of this study suggest three conclusions. First, the learning outcomes of nursing clinical practice should be developed based on the needs of students and should enhance their abilities in terms of self-reflection and ethical understanding. Second, in order to attain intended educational outcomes, students must gain a strong grasp of theory and professional knowledge; enhance their ability to communicate and cooperate with others; and strengthen their ability to work independently, responsibly, and compassionately. Third, the teacher should apply different types of leadership approaches to promote the autonomy of students and should develop a friendly relationship with them.